Psychological Distress is Associated With Blunt Use Among Youth in the United States: Insights From the 2021–2023 National Youth Tobacco Surveys

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INTRODUCTION: Blunts (hollowed-out cigars filled or mixed with cannabis) are popular among youth. Research on psychological distress and other determinants of blunt use is scant. This study examined factors associated with blunt use among a nationally representative sample of US youth. METHODS: Data were from the 2021-2023 (n = 68 253) cross-sectional National Youth Tobacco Surveys. Anxiety and depression were assessed using the Generalized Anxiety Disorder scale and the Patient Health Questionnaire, dichotomized into yes/no categories. Youth reporting blunt use at least once in their lifetime were classified as having ever used blunts. To estimate the association between anxiety, depression, race, sexual orientation, and ever blunt use, we conducted weighted logistic regressions for middle and high school students, adjusted for demographics. RESULTS: The prevalence of ever blunt use increased from 7.5% to 7.7% from 2021 to 2022, then decreased to 6.6% in 2023. High school students identifying as bisexual (1.26, [1.04,1.52]) (vs. straight) had higher odds of ever blunt use. Hispanic (1.21, [1.00,1.45]) and non-Hispanic (NH) Black high school students (1.59, [1.27, 2.00]) (vs. NH White youth) were more likely to report ever blunt use. High school students with anxiety (1.29, [1.11,1.50]) and depression (1.38, [1.18, 1.60]) had higher odds of ever blunt use compared to youth without these conditions. Similar results were observed for middle school students. CONCLUSIONS: Middle and high school students who reported psychological distress, or identified as bisexual, Hispanic, or NH Black were more likely to report ever blunt use. Findings underscore the importance of cannabis use control efforts designed to reach minoritized communities and those with psychological distress. IMPLICATIONS: Using 2021-2023 National Youth Tobacco Survey data, this study underscores the critical need for targeted interventions in cannabis control, particularly among marginalized youth, and those with psychological distress. The findings highlight higher ever blunt use among youth identifying as bisexual, Hispanic, or non-Hispanic Black, and youth who reported psychological distress, emphasizing the necessity for targeted prevention, and support initiatives within these communities.

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